Cardiac arrhythmias in the athlete: the evolving role of electrophysiology.
ABSTRACT Arrhythmia management has undergone a revolution in the past decade. The diagnosis and treatment of arrhythmias in the athlete can be complicated by the need to compete and exercise. Some arrhythmias may be benign and asymptomatic, but others may be life threatening. Sinus bradyarrhythmias are common and even expected in athletes; these are rarely a cause for concern. Heart block is unusual and merits a thorough work-up. Atrial fibrillation may be more common in the athlete, and supraventricular tachycardias other than atrial fibrillation warrant consideration of radiofrequency ablation for cure. Ventricular arrhythmias in the athlete generally occur in the setting of structural heart disease that is genetically determined (hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, anomalous coronary arteries), or acquired (coronary artery disease, myocarditis, idiopathic dilated cardiomyopathies). In these conditions the arrhythmia is life threatening. Ventricular arrhythmias that occur in the athlete without structural heart disease are not thought to be life threatening. Athletes with structural heart disease and those with exertional syncope merit a complete evaluation.
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ABSTRACT: Walking is purported to reduce the risk of atrial fibrillation by 48%, whereas jogging is purported to increase its risk by 53%, suggesting a strong anti-arrhythmic benefit of walking over running. The purpose of these analyses is to compare incident self-reported physician-diagnosed cardiac arrhythmia to baseline energy expenditure (metabolic equivalent hours per day, METhr/d) from walking, running and other exercise. Proportional hazards analysis of 14,734 walkers and 32,073 runners. There were 1,060 incident cardiac arrhythmias (412 walkers, 648 runners) during 6.2 years of follow-up. The risk for incident cardiac arrhythmias declined 4.4% per baseline METhr/d walked by the walkers, or running in the runners (P = 0.0001). Specifically, the risk declined 14.2% (hazard ratio: 0.858) for 1.8 to 3.6 METhr/d, 26.5% for 3.6 to 5.4 METhr/d, and 31.7% for ≥5.4 METhr/d, relative to <1.8 METhr/d. The risk reduction per METhr/d was significantly greater for walking than running (P<0.01), but only because walkers were at 34% greater risk than runners who fell below contemporary physical activity guideline recommendations; otherwise the walkers and runners had similar risks for cardiac arrhythmias. Cardiac arrhythmias were unrelated to walking and running intensity, and unrelated to marathon participation and performance. The risk for cardiac arrhythmias was similar in walkers and runners who expended comparable METhr/d during structured exercise. We found no significant risk increase for self-reported cardiac arrhythmias associated with running distance, exercise intensity, or marathon participation. Rhythm abnormalities were based on self-report, precluding definitive categorization of the nature of the rhythm disturbance. However, even if the runners' arrhythmias include sinus bradycardia due to running itself, there was no increase in arrhythmias with greater running distance.PLoS ONE 01/2013; 8(6):e65302. · 3.73 Impact Factor
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ABSTRACT: A growing number of publications describes a relation between intensive endu- rance exercise and the prevalence of atrial fibrillation. Existing data focus on the influence of endurance training in older male athletes. There is no evidence for an enhanced prevalence of atrial fibrillation in younger male athletes and in female athletes of any age. The prevalence of atrial fibrillation seems to have an U-shaped dose dependency in relation to athletic activity. No athletic activity and intensive athletic activity are associated with the incidence of atrial fibrillation, whereas light to moderate exercise seems to have a protective influence. Atrial fibrillation is caused by alterations in the complex interactions between ar- rhythmogenic triggers in the pulmonary veins, the substrate of the left atrium and influences of the autonomic nervous system. There is no evidence for an enhanced activity of arrhythogenic triggers in the pulmonary veins in athletes. Therefore, changes of the left atrial substrate are the most likely reason. Histological changes and increase of left-atrial size have to be considered. Also, the pronounced amplitude of the autonomic nervous system can contribute to the development of atrial fibrillation. If atrial fibrillation affects the mortality in athletes, is not studied yet. Therefore, the positive effect of regular exercise on health is indisputable und not restricted by the existing data. For athletes with highly symptomatic atrial fibrilla- tion and unsuccessful drug therapy, ablation should be considered.Deutsche Zeitschrift für Sportmedizin 01/2010; 61(9):4-14. · 0.58 Impact Factor
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ABSTRACT: Atrial fibrillation (AF) is the most common arrhythmia worldwide, and it has a significant effect on morbidity and mortality. It is a significant risk factor for stroke and peripheral embolization, and it has an effect on cardiac function. Despite widespread interest and extensive research on this topic, our understanding of the etiology and pathogenesis of this disease process is still incomplete. As a result, there are no set primary preventive strategies in place apart from general cardiology risk factor prevention goals. It seems intuitive that a better understanding of the risk factors for AF would better prepare medical professionals to initially prevent or subsequently treat these patients. In this article, we discuss widely established risk factors for AF and explore newer risk factors currently being investigated that may have implications in the primary prevention of AF. For this review, we conducted a search of PubMed and used the following search terms (or a combination of terms): atrial fibrillation, metabolic syndrome, obesity, dyslipidemia, hypertension, type 2 diabetes mellitus, omega-3 fatty acids, vitamin D, exercise toxicity, alcohol abuse, and treatment. We also used additional articles that were identified from the bibliographies of the retrieved articles to examine the published evidence for the risk factors of AF.Mayo Clinic Proceedings 04/2013; 88(4):394-409. · 5.79 Impact Factor